Bleiziffer, Sabine, Erlebach, Magdalena, Simonato, Matheus, Pibarot, Philippe, Webb, John, Capek, Lukas, Windecker, Stephan, George, Isaac, Sinning, Jan-Malte, Horlick, Eric ORCID: 0000-0003-1303-0586, Napodano, Massimo, Holzhey, David M., Petursson, Petur, Cerillo, Alfredo, Bonaros, Nikolaos, Ferrari, Enrico ORCID: 0000-0002-2837-3242, Cohen, Mauricio G. ORCID: 0000-0003-2038-6070, Baquero, Giselle, Jones, Tara L., Kalra, Ankur, Reardon, Michael J., Chhatriwalla, Adnan, Gama Ribeiro, Vasco, Alnasser, Sami, Van Mieghem, Nicolas M., Rustenbach, Christian Joerg, Schofer, Joachim, Garcia, Santiago, Zeus, Tobias, Champagnac, Didier, Bekeredjian, Raffi, Kornowski, Ran, Lange, Ruediger and Dvir, Danny (2018). Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve. Heart, 104 (10). S. 828 - 835. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-201X

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Abstract

Objective We aimed to analyse the incidence of prosthesis-patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event. Methods A total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as >= 20mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls). Results Moderate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta -0.023; 95% CI -0.032 to -0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta -0.11; 95% CI -0.161 to -0.071; P<0.001), higher BMI (unstandardised beta -0.01; 95% CI -0.013 to -0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta -0.064; 95% CI -0.095 to -0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44). Conclusions Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Bleiziffer, SabineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Erlebach, MagdalenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Simonato, MatheusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pibarot, PhilippeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Webb, JohnUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Capek, LukasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Windecker, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
George, IsaacUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sinning, Jan-MalteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Horlick, EricUNSPECIFIEDorcid.org/0000-0003-1303-0586UNSPECIFIED
Napodano, MassimoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Holzhey, David M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Petursson, PeturUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cerillo, AlfredoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bonaros, NikolaosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ferrari, EnricoUNSPECIFIEDorcid.org/0000-0002-2837-3242UNSPECIFIED
Cohen, Mauricio G.UNSPECIFIEDorcid.org/0000-0003-2038-6070UNSPECIFIED
Baquero, GiselleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jones, Tara L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kalra, AnkurUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reardon, Michael J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chhatriwalla, AdnanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gama Ribeiro, VascoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alnasser, SamiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Van Mieghem, Nicolas M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rustenbach, Christian JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schofer, JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Garcia, SantiagoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zeus, TobiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Champagnac, DidierUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bekeredjian, RaffiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kornowski, RanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lange, RuedigerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dvir, DannyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-186933
DOI: 10.1136/heartjnl-2017-312422
Journal or Publication Title: Heart
Volume: 104
Number: 10
Page Range: S. 828 - 835
Date: 2018
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 1468-201X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PROSTHESIS-PATIENT MISMATCH; BIOPROSTHETIC SURGICAL VALVES; HIGH-RISK PATIENTS; TRANSCATHETER; REPLACEMENT; IMPLANTATION; IMPACT; ASSOCIATION; SURVIVAL; REGISTRYMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/18693

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